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Obesity and Health System Reform: Private vs. Public Responsibility

Published online by Cambridge University Press:  01 January 2021

Y. Tony Yang  and
Len M. Nichols
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Extract

The obesity epidemic is not only impairing the health of millions of Americans but also giving rise to billions of added dollars in health care spending. Climbing rates of obesity over the past decades are one of the predominant determinants behind the surging progression of health care expenses in the United States. Moreover, the less fit and less productive U.S. workforce has gradually eroded the nation’s industrial competitiveness. Since the early 1970s, adult obesity rates have doubled and childhood obesity rates have more than tripled, while health expenditures have risen two percentage points faster than the Gross Domestic Product (GDP), burgeoning from 8.8 percent in 1980 to a projected 17.9 percent in 2011. Studies analyze that greater than a quarter of America’s health care expenses are attributed to obesity. The stunning growth in obesity has been imputed for 20 to 30 percent of the increase in health care costs since the late 1970s. If the proportion of obese population had stayed unchanged, then health care expenditures in America would be approximately 10 percent less on a per capita average than they are today.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 39 , Issue 3 , Fall 2011 , pp. 380 - 386
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

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References

U.S. Centers for Disease Control and Prevention, National Center for Health Statistics, Health, United States, 2003, Atlanta, GA, U.S. Department of Health and Human Services, 2003.Google Scholar
Center on Budget and Policy Priorities, “The Long-Term Fiscal Outlook Is Bleak: Restoring Fiscal Sustainability Will Require Major Changes to Programs, Revenues, and the Nation's Health Care System,” available at <http://www.cbpp.org/cms/index.cfm?fa=view&id=2215> (last visited June 24, 2011). (last visited June 24, 2011).' href=https://scholar.google.com/scholar?q=Center+on+Budget+and+Policy+Priorities,+“The+Long-Term+Fiscal+Outlook+Is+Bleak:+Restoring+Fiscal+Sustainability+Will+Require+Major+Changes+to+Programs,+Revenues,+and+the+Nation's+Health+Care+System,”+available+at++(last+visited+June+24,+2011).>Google Scholar
Kaiser Family Foundation, “Health Care Spending in the United States and OECD Countries,” available at http://www.kff.org/insurance/snapshot/chcm010307oth.cfm (last visited June 24, 2011).Google Scholar
Sisko, A. Truffer, C. Smith, S. et al., “Health Spending Projections through 2018: Recession Effects Add Uncertainty to the Outlook,” Health Affairs Web Exclusive (February 24, 2009), available at <http://content.healthaffairs.org/content/28/2/w346.full.html> (last visited June 29, 2011).CrossRef+(last+visited+June+29,+2011).>Google Scholar
U.S. Centers for Disease Control and Prevention, “Preventing Obesity and Chronic Diseases through Good Nutrition and Physical Activity,” U.S. Department of Health and Human Services, available at <http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf> (last visited June 29, 2011); Anderson, L. H. et al., “Health Care Charges Associated with Physical Inactivity, Overweight, and Obesity,” Preventing Chronic Disease 2, no. 4 (October 2005): 1–12.Google Scholar
Congressional Budget Office, Technology, Change, and the Growth of Health Care Spending, U.S. Government Printing Office, Washington, D.C., January 2008; Partnership to Fight Chronic Disease, “An Unhealthy Truth: Rising Rates of Chronic Disease and the Future of Health in America,” available at <http://c0573212.cdn.cloudfiles.rackspacecloud.com/UnhealthyTruth.ppt> (last visited April 5, 2011).+(last+visited+April+5,+2011).>Google Scholar
Finkelstein, E. A. DiBonaventura, M. Burgess, S. M. Hale, B. C., “The Costs of Obesity in the Workplace,” Journal of Occupational and Environmental Medicine 52, no. 10 (October 2010): 971–976.CrossRefGoogle Scholar
Thorpe, K. E. Florence, C. S. Howard, D. H. Joski, P., “The Impact of Obesity on Rising Medical Spending,” Health Affairs Supp. Web Exclusives (2004): W4-480-486.CrossRefGoogle Scholar
Finkelstein, E. A. Trogdon, J. C. Cohen, J. W. Dietz, W., “Annual Medical Spending Attributable to Obesity: Payer- and Service-Specific Estimates,” Health Affairs 28, no. 5 (2009): W822-w831.Google Scholar
Id.Google Scholar
Id.Google Scholar
Gates, D. M. Succop, P. Brehm, B. J. Gillespie, G. L. Sommers, B. D., “Obesity and Presenteeism: The Impact of Body Mass Index on Workplace Productivity,” Journal of Occupational and Environmental Medicine 50, no. 1 (2008): 39–45; Loeppke, R. Taitel, M. Haufle, V. Parry, T. Kessler, R. C. Jinnett, K., “Health and Productivity as a Business Strategy: A Multiemployer Study,” Journal of Occupational and Environmental Medicine 51, no. 4 (2009): 411–428; Goetzel, R. Z. Liss-Levinson, R. C. Goodman, N. Kennedy, J. X., “Development of a Community-Wide Cardiovascular Risk Reduction Assessment Tool for Small Rural Employers in Upstate New York,” Preventing Chronic Disease 6, no. 2 (2009): A65.CrossRefGoogle Scholar
Ricci, J. A. Chee, E., “Lost Productive Time Associated with Excess Weight in the U.S. Workforce,” Journal of Occupational and Environmental Medicine 47, no. 12 (2005): 1227–1234.CrossRefGoogle Scholar
Id.Google Scholar
Id.Google Scholar
See Finkelstein, et al., supra note 7.Google Scholar
Id.Google Scholar
PPACA, at § 4205.Google Scholar
Id., at § 4306.Google Scholar
Id., at § 4201.Google Scholar
Id., at § 1001.Google Scholar
Id., at § 1001.Google Scholar
Id., at § 1201.Google Scholar
Id., at § 1201.Google Scholar
Jochelson, K., Nanny or Steward? The Role of Government in Public Health (London: King's Fund), available at <http://www.kingsfund.org.uk/publications/nanny_or.html> (last visited July 1, 2011).Google Scholar
Gortmaker, S. et al “Social and Economic Consequences of Overweight in Adolescence and Young Adulthood,” New England Journal of Medicine 329, no. 14 (September 30, 1993): 1008–1002.CrossRefGoogle Scholar
Some might feel similarly about and have a willingness to pay to improve the life chances of drug addicts, orphans, single mothers, and various forms of vulnerable populations, etc.Google Scholar
Hammond, R. Levine, R., “The Economic Impact of Obesity in the United States,” Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy 17, no. 3 (August 2010): 285–295.CrossRefGoogle Scholar
Balko, R., “Private Matters and ‘Public Health,’” available at <http://www.cato.org/pub_display.php?pub_id=4095> (last visited July 1, 2011).+(last+visited+July+1,+2011).>Google Scholar
See Hammond, Levine, , supra note 28, for a recent literature review of the range of findings in this literature.Google Scholar
Most economists argue that most if not all of employer premium contributions are paid for by workers through reduced wages, but firms probably bear at least some of the cost for extended periods of time, for it is difficult to adjust wages perfectly and quickly in the face of somewhat unpredictable health insurance inflation. Thus, we assume incidence is shared between workers and employers.Google Scholar
Bhattacharya, J. Bundorf, M. K., “The Incidence of the Healthcare Costs of Obesity,” Journal of Health Economics 28, no. 3 (2009): 649–658.CrossRefGoogle Scholar
Bhattacharya, J. Sood, N., “Health Insurance and the Obesity Externality,” January 2006, available at <http://www.randproject.org/pubs/working_papers/2006/Rand_WR340.pdf> (last visited June 24, 2011).CrossRef+(last+visited+June+24,+2011).>Google Scholar
See Finkelstein, et al., supra note 9.Google Scholar
See Hammond, Levine, , supra note 28.Google Scholar
Id.Google Scholar
Id.Google Scholar
American Medical Association, AMA Adopts Policies to Promote Healthier Food Options to Fight Obesity in America, News Release, June 27, 2007, available at <http://www.highbeam.com/doc/1P2–13242635.html> (last visited March 27, 2011).+(last+visited+March+27,+2011).>Google Scholar
Rudd Center for Food Policy and Obesity, “Menu Labeling Laws,” available at <http://yaleruddcenter.org/what_we_do.aspx?id=124> (last visited June 24, 2011).+(last+visited+June+24,+2011).>Google Scholar
NCSL, “Trans Fat and Menu Labeling Legislation,” available at <http://www.ncsl.org/default.aspx?tabid=14362> (last visited June 24, 2011).+(last+visited+June+24,+2011).>Google Scholar
Id.Google Scholar
Pereira, M. Kartashov, A. Ebbeling, C. et al., “Fast Food Habits, Weight Gain, and Insulin Resistance (the CARDIA Study): 15-Year Prospective Analysis,” The Lancet 365, no. 9453 (2005): 36–42.CrossRefGoogle Scholar
Roberto, C. A. Schwartz, M. B. Brownell, K. D., “Rationale and Evidence for Menu-Labeling Legislation,” American Journal of Preventive Medicine 37, no. 6 (2009): 546–51.CrossRefGoogle Scholar
Mathios, A. D. Ippolito, P., “Health Claims in Food and Advertising and Labeling: Disseminating Nutrition Information to Consumers,” in America's Eating Habits: Changes and Consequences, USDA: Economic Research Service, Food and Rural Economics Division, Agriculture Information Bulletin No. 750., Washington, D.C., 1999, at 189–212.Google Scholar
Mayer, J. A. Maciel, T. L. Orlaski, P. L. Flynn-Polan, G., “Misleading Nutrition Claims on Cracker Packages Prior to and Following Implementation of the Nutrition Labeling and Education Act of 1990,” American Journal of Preventative Medicine 14, no. 3 (1998): 189–195.Google Scholar
Young, L. Swinburn, B., “Impact of the Pick the Tick Food Information Programme on the Salt Content of Food in New Zealand,” Health Promotion International 17, no. 1 (2002): 13–19.CrossRefGoogle Scholar
Bassett, M. T. Dumanovsky, T. Huang, C. et al., “Purchasing Behavior and Calorie Information at Fast-Food Chains in New York City, 2007,” American Journal of Public Health 98, no. 8 (2008): 1457–1459.CrossRefGoogle Scholar
Technomic Inc., Executive Summary: Consumer Reaction to Calorie Disclosure on Menus/Menu Boards in New York City, February 2009.Google Scholar
Roberto, C. A. Larsen, P. D. Agnew, H. Baik, J. Brownell, K. D., “Evaluating the Impact of Menu Labeling on Food Choices and Intake,” American Journal of Public Health 100, no. 2 (2010): 312–318.CrossRefGoogle Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Cole, C. Balasubramanian, S. K. Castellano, N. M., “Individual Differences in Consumers' Willingness to Use Nutritional Information,” in Sherry, J. F. Sternthal, B., eds., Advances in Consumer Research, Association for Consumer Research, Provo, UT, 1992.Google Scholar
Simon, P. J. Kuo, T. Fielding, J. E., “Menu Labeling as a Potential Strategy for Combating the Obesity Epidemic: A Health Impact Assessment,” Los Angeles County Department of Public Health, Los Angeles, CA, 2008.Google Scholar
NIHCM, Building a Stronger Evidence Base for Employee Wellness Programs, available at <http://www.nihcm.org/pdf/Wellness%20FINAL%20electonic%20version.pdf> (last visited June 29, 2011).+(last+visited+June+29,+2011).>Google Scholar
Ozminkowski, R. J. Ling, D. Goetzel, R. Z. et al., “Long-Term Impact of Johnson & Johnson's Health & Wellness Program on Health Care Utilization and Expenditures,” Journal of Occupational and Environmental Medicine 44, no. 1 (2002): 21–29.CrossRefGoogle Scholar
PPACA, Section § 4303.Google Scholar